In the preceding article we spoke of three distinct phases of school health education, and covered the first phase, or healthful school living. The second section, health service, includes "the examinations for disease and defect, the protective measures of first aid, vaccinations, and inoculations, and the follow-up corrective -procedures for children with defects."—"Administration of Health and Physical Education," Williams and Brownell, p. 55. In the past, this phase of the health program has perhaps received the lion's share of the nurse's attention. This is still quite proper if the aims and objectives of health service are kept in mind.
"The health examination is one of the most valuable ways of providing an educational experience in healthful living which has both present and future values. It should be evaluated by the same criteria applied to other health projects. . . . Since this is to be an educational experience, it should be planned by the teacher as well as by the nurse and the physician."—Chayer, "School Nursing," p. 59.
The functions of the examination have been listed as follows by Williams and Brownell, (p. 166) :
1. To determine the presence of defects.
2.To acquaint parents with the nature of these defects.
3.To secure correction of remediable defects. 4- To develop a scientific attitude toward disease and bodily disturbances.
To review the whole scope of the health service, the nurse will find most helpful Chayer's "School Nursing," New York, Putnam, 1937; Morrison and Chenoweth's "Normal and Elementary Physical Diagnosis," second ed., Philadelphia, Lea and Febiger, 1932; Chenoweth and Selkirk's "School Health Problems," New York, Crofts and Co., 1930; and the pamphlet, "Health Education and Inspection for Church Schools," issued by the Educational and Medical Departments of the General Conference, Takoma Park, Washington, D. C. If Williams and Brownell's "Administration of Health and Physical Education" is available, pages 159-233 of this work would also be of value.
The exact procedure for the health appraisal will depend upon the medical facilities available. Considerable screening on the part of the teacher may be advisable even before the nurse arrives. For example, if the teacher has been taught the proper technics, it is perfectly acceptable that she should give a screening test for vision. Again, if a physician is available, the nurse will complete a portion of the inspection before he arrives.
In some public schools, physicians are paid from five to ten dollars an hour for school health examinations. The Home and School Association sometimes raises money for such a plan. Many localities have a Seventh-day Adventist doctor who might be willing to donate his services. Parents should be encouraged to take their children to the family physician for a health appraisal more thorough than any given at school. In such cases the family physician should be provided with the Physical Inspection Record used in the conference. Ideally, a dentist should examine the teeth. If possible, arrangements should be made for such service. The White House Conference states that if there is no physician, the nurse should make a yearly inspection of all children, including :
"Testing visual acuity and eye defects.
Testing hearing and inspecting for defects. Inspection of the general conditions of the mouth, teeth, gums, nose and throat, tonsils, and nasal breathing.
Inspection of cervical and thyroid glands.
Inspection of general condition of the bony framework.
Inspection for symptoms of nervousness.
Inspection for condition of the skin.
General impression of the well-being of the child."
—White House Conference, "The School Health Program," p. 208.
Careful study of the material sent from the General Conference is invaluable and necessary if we are to have uniformity of procedure throughout our organization. Some blanks are to be revised in the near future, I understand. Nurses interested in experimentation will receive friendly encouragement from the Medical Department in Washington, D. C.
For testing vision it is now recommended that the Snellen Symbol E Chart be used for all age groups. This chart can be purchased from the National Society for the Prevention of Blindness at 25 cents each if several are purchased at one time. (I have found the paper finish more satisfactory than the linen.) A metal standard for sheet music can be used for the base of a standard, which can be made of thin board and painted black, to hold the Snellen Chart. This makes possible the placing of the chart in the best location regardless of wall space. Mary Ella Chayer, in "School Nursing," gives a complete list of directions for making the vision test. (See pages 126 to 130.)
On pages 134 to 139, Chayer also gives instruction regarding hearing tests. It is felt that all tests other than the audiometer are "as archaic as the use of the leech by the medical profession." Since the hard-of-hearing child is in great need of both diagnosis and treatment, provision should be made for audiometer tests in all the schools. F. M. Duckles, executive secretary, California Committee for Hard of Hearing Children, Box 173, Berkeley, California, can give information on all apparatus. He can demonstrate the Phantom Junior Hearing Aid for the child who must attend the regular classes with normal children. It is a crystal set with ear phones, and can be carried about the room as needed ($39.50 to schools).
If an audiometer is not available, the nurse should study community resources in each school area to see what can be done by city or county organizations. In fact, such contacts should be made regarding many phases of the school health program.
Nutrition presents such a broad field that the nurse may feel that she needs more information. The following references may prove helpful : Bogert, L. J., "Nutrition and Physical Fitness," Philadelphia, W. B. Saunders Company, 1940; Bureau of Home Economics, "Well Nourished Children," United States Department of Agriculture (free) ; Roberts, L. J., "Nutrition Work With Children," Chicago, University of Chicago Press, 1935; Rose, M. S., "Feeding the Family," New York, Macmillan.
The most satisfactory chart for height and weight is the "Classroom Growth Record," National Education Association, 1201 Sixteenth Street, N. W., Washington, D. C. In place of the old-fashioned "standards" for normal weight, the chart states, "It is more important to know that a child is gaining than that he or she weighs any particular amount at a certain time." The Leland Stanford University has prepared tables based on width weight which aid in certain borderline nutritional conditions. Width may be more accurate than height as a basis for comparison with the average. In using any tables of so-called normal weight, we must keep in mind that the figures are based on averages, and must be used only to indicate trends.
It will be noticed that form C-26, used for the physical inspection, provides brief space for a history of communicable diseases, immunizations, etc. If duplicates of this form are not left with the teacher, this history, at least, should be placed in her hands. It will be useful to her in dealing with day-by-day problems of illness among her students. In fact, the teacher may procure this information the first day of school when parents bring their children to register.
Again, time and space do not permit a more exhaustive discussion of the health appraisal in the school. Parents should have been informed of the date of the inspection and urged to attend. After the inspection, notes regarding either defects or the lack of any defects should be sent to all parents. The nurse should remain in the community long enough to have a meeting with the Home and School Association. As many home visits should be made as time will permit. Miss Chayer says, "Home calls have three immediate purposes—self-information, or what the nurse learns ; health service, or what the nurse does ; and health education, or what the family learns. .. . To do effective teaching in the home, the nurse must plan her call in advance."—"School Nursing," p. 246. When the nurse leaves the school, she must be sure that adequate records of the condition of each child are left in the hands of the teacher, for—
"In many rural situations, the nurse and the classroom teacher are responsible for the health of the child in school. Since the nurse who has a large area to cover can visit her schools only once or twice a year, the classroom teacher must be prepared to take the larger measure of responsibility."—White House Conference, Id p.
Third Section—Health Education
The third section of health education, that of health instruction, deals with "the materials by which children are helped to acquire health habits, learn health skills, master health knowledge, and develop health attitudes."—/bid.
The key person in health education must be the teacher, who is with the children day by day, while the medical folk come and go. "The teacher is responsible for the quality of health teaching done in the school." "The 'spark plug' in this must be the classroom teacher." The nurse does have an important place, but not as it was first conceived in early programs.
"When the nurse of the past started her work in the schools, health talks were among her activities for changing behaviour. At varying intervals she went into a classroom and talked to the children about their health, or about keeping clean, or about eating the right kind of food, and unfortunately, many were the pedagogical principles which she violated."—Chayer, "School Nursing," p. 20.
Miss Chayer continues by pointing out a few of the most significant faults in such a plan. The aims of the teacher and the nurse were not co-ordinated; little provision was made for any continuous growth, with no connection between one health talk and the next ; and the talks were not necessarily graded to the abilities of the age groups. On the other hand there were good results. A new kind of informal teaching was introduced, a great deal of knowledge was given to the children, and the teacher became more intelligent regarding health. (Id., pp.-2o, 21.) There is certainly no objection to a nurse's giving health talks to school children if she keeps in mind that she and the teacher must co-operate at all times.
"The teacher and the nurse, now having a common aim, together built up the health program, the nurse furnishing the teacher with a scientific basis for health teaching by calling attention to health shortages revealed by the health examinations and by vital statistics of the community. The nurse also contributed a wealth of source materials to help the teacher to place her health teaching on a more scientific basis."—Id„ p. 22.
The nurse should interest herself in plans for health instruction as they are being carried out in the schools of her conference. She should assist the teacher in using the Gold Star Chart and the Health Habit records. She should know of the use being made of the weekly period set apart for health, and of plans for health integration. She must be familiar with literature in the field of health instruction. Bibliographies, such as the one found on pages 311 to 361 of "Health Education," Joint Committee on Health, National Education Association, 1940 edition, give abundant sources. Teachers should feel free to write to the conference nurse, between visits, for helps in health education. As -the instruction is carried on in the school, "the primary aim which the nurse and all other health workers must hold constantly before their attention is this—for every child continuous and satisfactory growth in control of conduct contributory to health."—Ibid.
As the conference nurse continues her work in the church schools, she will wish to check herself as to accomplishments. This list, prepared by the National Organization for Public Health Nursing, regarding the functions of the public health nurse in the school, may aid her :
1. Participates in formulating and developing a health education program based on the needs of the pupils.
2. Assists physicians in the examination of pupils and the interpretation of findings to teachers, parents, and children.
3. Teaches the value of adequate health supervision and facilities for medical and nursing care, and assists in securing correction of defects.
4. Encourages and instructs teachers, parents, and pupils to observe and recognize deviations from normal health.
5. Assists in the control of communicable diseases through teaching the recognition of early symptoms, the importance of isolation, and the value of immunization.
6. Contributes to the maintenance of a healthful school environment—physical, emotional, and social.
7. Arranges for the care of emergencies and minor injuries and illnesses in accordance with procedures having medical approval.
8. Participates in a program for the prevention of handicaps and the care and education of handicapped children.
9. Develops relationships to co-ordinate school nursing activities with all other health forces of school, home, and community, and to promote community health resources.
10. Participates in curriculum making. Nurses who are qualified may instruct classes in principles of healthful living and care of the sick.—Public Health Nursing, February, 1938,
In order to further the successful program of a nurse in a conference, the following recommendations, given by the White House Conference for the School Health Program in the Elementary Schools, are repeated for the further study of all concerned with the work :
1. The essential importance of home-school-community co-operation in any program for health education should be given great recognition.
2. The total school life should be considered from the viewpoint of child learning respecting health conduct. Time schedules should admit of health instruction's being given in its natural relationships and individualized to meet the needs of each child.
3. The various special fields which are involved in health education, such as nutrition, safety education, and social hygiene, should be more effectively integrated in the instructional and supervisory program, and not handled as separate subjects.
4. Scientific research should be carried on to determine for this age group essential health behaviors and knowledge which is necessary to rationalize behavior satisfactorily.
5. Better provision should be made for preparing the classroom teacher for her responsibilities in health education.
6. Schools should make more adequate plans for educational evaluation, from the viewpoint of total child welfare, of all services, methods, and materials offered in schools for use in health education before they are accepted and used.
7. More recognition should be given to the importance of supervision in articulating and making effective the curriculum in health education, and further investigation should be made of the relative effectiveness of different types of supervision.—Page 160.
May I emphasize the importance of recommendation five in the foregoing list. Our own colleges should incorporate more health education into the teacher-training curriculum. Courses should include a thorough foundation in human physiology and hygiene, child health, first aid, physical education including methods, and, if possible, a course in home hygiene and care of the sick. All of these courses are now being offered in our colleges, but future teachers are allowed to be graduated with few if any of them in their individual programs.
I should also like to recommend that the conference nurse be encouraged to continue her education in the field of public health nursing, working toward State recognition as a Public Health nurse,
Furthermore, I would recommend that the conference nurse be delegated the authority for a general health program in the conference, and that she should not be removed to some other activity demanding the bulk of her time. If satisfactory work is to be done, the nurse must be allowed sufficient time for the school health program, with adequate opportunity for follow up.
(End of Series)